Healthcare Provider Details

I. General information

NPI: 1265269856
Provider Name (Legal Business Name): JENNIFER STUMBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 STEWART ST
WELCH WV
24801-2125
US

IV. Provider business mailing address

24060 COAL HERITAGE RD
WELCH WV
24801-2955
US

V. Phone/Fax

Practice location:
  • Phone: 304-436-6588
  • Fax: 304-436-2006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: